Review regularly (eg, every 3 mo) the date of initiation, indications, dose, effectiveness, and adverse drug reactions or unwanted effects of all medications.88 Involve a pharmacist to review medications whenever possible.86
Establish baseline and monitor
For potentially toxic medications, or those with drug-organ or drug-drug interactions, establish a baseline for the patient and monitor at the recommended interval for each.88
Educate and simplify
Educate the person and caregivers about appropriate use of medications, interactions with over-the-counter, alternative, and as-needed medications, and to report potential adverse drug events. Provide patients and caregivers an opportunity to discuss questions about medication.89, 90 Determine the patient’s capacity and need for supports for both decision making and medication adherence.91 Simplify the medication administration routines and recommend appropriate medication administration aids (eg, dosettes, blisterpacks) and other needed supports.
Stopping Over Medication of People with a Learning Disability
Stopping Over Medication of People with a Learning Disability (STOMP-LD) is a national project in the United Kingdom by the Nation Health Service (NHS) and other organizations to stop the overuse of psychotropic medicines in people with intellectual and developmental disabilities. The STOMP website includes videos for physicians and nurses and other resources for health care professionals on prescribing psychotropic medication for people with intellectual and developmental disabilities.
Learn how to implement these guideline recommendations into your practice from selected articles in the special issue on primary care of adults with intellectual and developmental disabilities in Canadian Family Physician, Vol 64 (suppl 2): S1-78, April 2018:
- Cobigo V, Ouellette-Kuntz HMJ, Lake JK, Wilton AS, Lunsky Y. Chapter 6: Medication use. In: Lunsky Y, Klein-Geltink JE, Yates EA, editors. Atlas on the primary care of adults in Ontario. . [Internet]. Toronto: Centre for Addiction and Mental Health and Institute for Clinical Evaluative Sciences; 2013. p. 117-36.
- Haider SI, Ansari Z, Vaughan L, Matters H, Emerson E. Prevalence and factors associated with polypharmacy in Victorian adults with intellectual disability. Res Dev Disabil. 2014;35(11):3071-80.
- O’Dwyer M, Peklar J, McCallion P, McCarron M, Henman MC. Factors associated with polypharmacy and excessive polypharmacy in older people with intellectual disability differ from the general population: A cross-sectional observational nationwide study. BMJ Open. 2016;6(4):e010505,2015-010505.
- Scheifes A, Egberts TC, Stolker JJ, Nijman HL, Heerdink ER. Structured medication review to improve pharmacotherapy in people with intellectual disability and behavioural problems. J Appl Res Intellect Disabil. 2016;29(4):346-55.
- NHS England. Stopping over-medication of people with a learning disability or autism or both [STOMP] [Website]. NHS England. 2016. Accessed 2017 Sep 13.
- Branford D, Bhaumik S. Chapter 2: Prescribing practice. In: Bhaumik S, Branford D, Barrett M, Gangadharan SK, editors. The Frith prescribing guidelines for people with intellectual disability. 3rd ed. Chichester, West Sussex ; Hoboken, NJ: John Wiley & Sons Inc.; 2015. p. 11-9.
- Fish R, Hatton C, Chauhan U. “Tell me what they do to my body”: A survey to find out what information people with learning disabilities want with their medications. Br J Learn Disabil. 2017;45(3):217-25.
- Erickson SR, LeRoy B. Health literacy and medication administration performance by caregivers of adults with developmental disabilities. J Am Pharm Assoc. 2015;55(2):169-77.
- Ferguson L, Murphy GH. The effects of training on the ability of adults with an intellectual disability to give informed consent to medication. J Intellect Disabil Res. 2014;58(9):864-73.